Project Summary/Abstract Adolescents with type 1 diabetes (T1D) often experience deteriorations in glycemic control that can persist into adulthood. Although family-based interventions are empirically supported to offset this adolescent risk, such behavioral health services are rarely included in diabetes care. This K23 proposal seeks to bridge this gap between research and practice by optimizing family-based programs to provide the most efficacious, judicious, and streamlined intervention possible to adolescents with T1D. The proposed study aims to 1) pilot and evaluate specific family-based intervention components, and 2) identify the factors that explain and influence intervention effects. First, the candidate will use qualitative methods to pilot 3 intervention modules to assess feasibility and acceptability. Each module corresponds to one of 3 critical family processes: parental monitoring, parental involvement, and parent-adolescent conflict, each of which are empirically linked to adolescent diabetes management and glycemic control and are common family-based intervention targets. Next, the candidate will conduct an experimental trial of the intervention modules to evaluate their relative efficacy as well as combined impact on adolescent outcomes. Finally, the candidate will conduct advanced statistical analyses to verify the specific family processes (including both general and diabetes-specific) that explain (mediate) program effects as well as the contextual factors that influence (moderate) intervention effects. This proposal will yield an optimized family-based intervention as well as provide critical empirical information about the causal pathways between family functioning, mental health, and glycemic control among adolescents with T1D. The K23 award offers the training, mentorship, protected time, and resources necessary to complete the proposed study and support Dr. Wong?s progress toward becoming an independent research scientist in pediatric diabetes.